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Abstract:

Despite advances made in the treatment of renal cell carcinoma, kidney cancer still remains a «surgical» disease. Radical surgery is the only cure for this pathology If it is technically impossible to perform a resection of the kidney in situ, it is preferable to use the latter treatment option, since it avoids chronic hemodialysis, the need for kidney transplantation and improve the quality of life. The central and intraparenchymal location of tumors does not allow the organ-preserving operation due to the necessity of resection of segmental vessels, cups and renal pelvis, which prolongs the time of thermal ischemia. Conducting extracorporeal resection of the kidney in conditions of chemo-cold ischemia allows you to expand indications for organ-preserving treatment of patients with localized kidney cancer.

Aim: was to evaluate possibilities of ultrasound monitoring during extracorporeal resection of the kidney with orthotopic nephropexy and replantation of renal vessels at all stages of surgical treatment.

Material and methods: 47 patients (74% of men, 26% of women) with a histologically confirmed diagnosis of kidney cancer were hospitalized for treatment at the period from March 2012 to the present in A.V Vishnevsky National Medical Research Center of Surgery All patients underwent extracorporeal resection of the kidney under conditions of pharmaco-cold ischemia without intersection of the ureter with orthotopic replantation of renal vessels. Ultrasound examination (in B-mode, Color and Energy Doppler Imaging and pulsed Doppler) was performed for all patients in the pre-, intra- and postoperative stages.

Results: the analysis of the ultrasound data obtained during the surgical treatment of patients at its stages allowed us to develop an algorithm for examining patients at stages of extracorporeal resection of the kidney under conditions of pharmaco-cold ischemia without crossing the ureter with orthotopic replantation of the renal vessels, taking into account technical features of surgical intervention

Conclusion: extracorporeal resection of the kidney with orthotopic nephropexy and replantation of renal vessels requires constant dynamic monitoring of the functional state of the renal blood flow Doppler ultrasound, performed according to the developed method, is a highly informative method in the qualitative and quantitative assessment of intrarenal blood flow. Ultrasound monitoring allows you to determine the functional state of the kidneys during the preoperative stage, intraoperatively assess the state of vascular anastomoses and monitor changes in the kidneys and the resectior zone in the postoperative period. 

 

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